粟粒型肺结核和粟粒性肺转移瘤的螺旋CT鉴别特征

目的探讨粟粒型肺结核和粟粒性肺转移瘤的螺旋CT表现特征,以提高肺部弥漫性粟粒性病变的影像诊断水平。方法收集经临床证实的34例粟粒型肺结核和54例粟粒性肺转移瘤的螺旋CT资料,观察肺粟粒结节的分布、大小,肺密度,肺门、纵隔淋巴结增大及肺内并发病灶。结果CT图像上,34例粟粒型肺结核中,结节均匀分布28例(28/34,82%),大小一致23例(23/34,68%),密度均匀25例(25/34,74%)以及毛玻璃征26例(26/34,76%)。54例粟粒性肺转移瘤的粟粒结节分布、大小、密度大多不均匀,分别为49例(49/54,91%),39例(39/54,72%),41例(41/54,76%),毛玻璃征(GGO)8例(8/54,15%)。两者在结节分布、大小、密度均匀性和伴毛玻璃征方面均有统计学差异(P<0.05)。肺内其它改变:9例(9/34,26%)结核的肺门和纵隔淋巴结增大,而肺转移瘤有29例(29/54,54%);结核性胸腔积液15例(15/34,44%),肺转移瘤30例(30/54,56%);心包积液中,结核8例(8/34,24%),肺转移瘤20例(20/54,37%)。结论血行播散型肺结核和粟粒性肺转移瘤在结节分布、大小和密度等方面螺旋CT表现特征明显不同,这些特征与它们的血行播散途径和相应的病理解剖改变有密切关系。

Differentiation Between Tuberculosis and Metastasis in Diffuse Pulmonary Miliary Nodules: Evaluation with Helical CT

Objective To evaluate the helical CT features of miliary tuberculosis and pulmonary miliary metastatic nodules so thatimproving the correct diagnosis of the miliary lung diseases.Methods Helical CT or high resolution CT features (distribution and size of miliary nodule and attenuation of the lung) of 34 patients with miliary tuberculosis and 54 patients with pulmonary miliary metastatic nodules were retrospectively reviewed.Results The uniformly distribution and size of the bilateral lung were observed in 28 (28/34, 82%) and 23 (23/34, 68%) cases of miliary tuberculosis,5(5/54, 9%) and15(15/54, 28%)cases of pulmonary metastases ( P<0.05 ) respectively. Miliary tuberculosis showed homogeneous nodules in 25(25/34, 74%) and ground glass opacity (GGO) in 26(26/34, 76%), whereas metastasis showed heterogeneous nodules in 41(41/54,76%) and GGO in 8(8/54, 15%)(P<0.05). There were lymphadenovarix of hilar and mediastinum, pleural and pericardial effusion in 9(26% ), 15( 44% ) and 8(24% ) cases of tuberculosis respectively, but in 29(54%), 30(56%) and 20 (37%) cases of metastasis respectively. Conclusion Miliary tuberculosis and metastasis with miliary nodules are of the different characteristics in distribution , size and density of the miliary nodules on CT , that are corresponded to their pathologic findings.